How is depression prevented following middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

The negative long- and short-term impact of poststroke depression is difficult to overstate. In short, poststroke depression increases mortality and healthcare usage and worsens both short- and long-term functional recovery. In addition, depression has been linked to subsequent loss of regained function, and this loss is often permanent, even after depression remits. Nonetheless, studies in the United States and abroad show that depression is more prevalent after stroke and is undertreated. Multiple screening tools have been shown to be reliable in the stroke population. [32]

Sertraline, citalopram, venlafaxine, and nortriptyline have all been shown to effectively treat depression after stroke. [33, 34] Whether this treatment improves mortality is still to be elucidated. Recent studies using fluoxetine have been less focused on depression and more focused on motor recovery. A few, including a relatively small but double-blinded, placebo-controlled study, have shown a significant improvement in motor recovery relative to an untreated cohort. Theoretically, this is thought to be due to modulation of cerebral plasticity. [35]


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